Tuesday, November 24, 2009

Coma Video Shows Use of Bogus "Facilitated Communication" Technique

By now you've probably heard the story of a man, thought to be in a coma for 23 years, who was recently "discovered" to be conscious the whole time.

Maybe so. But maybe not.

As James Randi points out, a video clearly shows that the man himself is not typing. Instead, a woman is shown using a technique called "facilitated communication", where she moves his hand to type on a keyboard. He is not moving his hand independently.

32 comments:

Aside from O'Leary's general credulity there are two reasons she'd buy into this 1) Conservatives can point to this as evidence that they were right about Terry Schiavo (never mind that this situation isn't at all similar and that the autopsy results in her case were unambiguous) 2) O'Leary is part of the growing segment of the ID/anti-science crowd which tries to focus on consciousness as somehow impossible to explain with science. Thus, any evidence of scientists or doctors making a mistake about cognition helps her establish her worldview.

It is interesting, the news reports I saw about this didn't point out that this was using facilitated communication. Should be interesting to follow this up and see if it turns out that the individual really is communicating or not.

If I might interrupt this obsession with O'Leary's possible motives, critical thinking skills and thought patterns, there's a bit more to the story than what has been provided here. CBC has a little more detailed report. Apparently, the man can provide feedback by pressing his foot on a input device, indicating 'yes' or 'no'. More recently, he has movement in one finger. I also notice in the CBC report that the doctor in charge of this case is Professor Steven Laureys of Belgium's Coma Science Group. Laureys has recently published a paper in BMC Neurology showing that about 40% of patients are wrongly diagnosed as being in a vegetative state. The ability of the man to independently signal whether or not he agrees with what is being typed, and his ability to move one finger, makes it doubtful that this team of scientists, headed by Laureys, is falling for fake messages typed out by a crackpot assistant.

On the other hand, I don't see this as evidence for the existence of a non-physical mind (although it doesn't falsify that notion either). It seems to me that the physical connection between his brain and the rest of his body has merely been badly damaged. Provided the brain is supplied with oxygen and nutrients, I don't see why it cannot continue to function even if totally disconnected from the rest of the body. In fact, it was through the use of more state of the art brain scanning technology that his brain was discovered to be fully functional. We can infer from this that there were physiochemical processes going on in his brain in spite of its weak neurological connection to the rest of his body.

I see that Caplan is also skeptical, yet he does not mention that the man has the ability to provide feedback. It makes a major difference in the credibility of what the patient is allegedly communicating as the assistant moves his hand if the patient can provide yes/no feedback. It is a relatively simple matter to use an X Y coordinate system for hand movements over a keyboard, controlled by a yes/no foot input.

I downloaded that Facilitated Communication (FC) paper and took a quick look at it. The paper seems to be dealing with studies done on severely autistic people, where there is no way for the patient to confirm that what is being typed is what the patient wants typed. The paper also notes that FC has largely been replaced by more advanced methods. Given that in this case under discussion the man can clearly signal yes/no, and looking over that FC paper, I'm not sure it is accurate to classify what Laureys' team is doing as what is being described in the FC paper. The patient is not autistic and can freely provide feedback by the yes/no foot input. Perhaps Randi and Caplan were unaware of the team of researchers in charge of this case or that they had already had a way to obtain yes/no feedback from the patient, in which case they may have been a little too hasty in their assessment. If they knew about the yes/no feedback but did not mention it, then Randi's and Caplan's comments misrepresent what Laureys et al. are doing. At the very least, Randi and Caplan need to address the fact that the man has yes/no input via his foot, and then explain why we should still think that the team of scientists are making up the patient's messages.

Yes, well one problem is that media reports seem to be all over the map as to what he allegedly has done and by what means. If he can do something non-random with his toe (ie. not somehow prompted and/or over-interpreted by his family and care-givers), then great. But there doesn't seem to be much in the way of verifiablity w.r.t. the FC procedure.

I never indicated whether I'm skeptical or not. I'm merely pointing out that I did watch the video and a couple others. All you see is the assistant moving the patient's hand, you do not see his foot, and you do not hear what the assistant is saying to the patient. I took the time to read a bit further. The fellow has the ability to provide yes/no feedback, which disqualifies his typing as FC. I've also downloaded Laureys paper and looked at the methods he uses. It seems to me that both Randi and Caplan did not do their homework and leapt to a conclusion based only on what they could see in the video.

Well I'm not going to make a federal case out of this, but the link to CBC news I provided in my first post states that the patient has the ability to signal yes/no with his foot on a computer input. The CBC video in that link I provided also shows that the patient has the ability to move his entire arm. Laureys and team has worked with the patient to develop a method to communicate and it consists of more than a quack making up messages by using his finger to type messages. If you just looked at the video that you selected, and had no other information, it certainly would look like FC. However, the info that CBC gives paints a more complete picture. The fact that the patient can provide yes/no feedback with his foot, removes the method of communication that Laureys et al have developed from being categorized as FC. What is being described in the 2001 paper you cited does not match the communication method that Laureys team has devised (i.e., if the patient can independently provide feedback to confirm or disconfirm the message, it is not FC). You can believe on the basis of that video that what we are seeing is some quack making up messages by using the patient's finger as a pointer if you want. All I am saying is that there is a lot more behind the story than merely that one video, and when one finds out that the patient can also provide feedback, the FC theory becomes doubtful. If there is independent feedback from the patient, then it is not FC as described in the 2001 review you referred to. However, perhaps you are right and the method of communication that Laureys' team has developed is nothing more than FC. I've emailed him, directing him to this blog, asking specifically how the patient can exercise control over what is being typed (in the video) if an assistant is moving his hand. He's probably swamped with media at the moment, but if he responds, I'll post his comments here.

I agree that the "facilitated communication" in the video looks suspicious. But, I wonder, is there not a single element of truth in that this person has, indeed, recovered? Perhaps not fully, maybe he's only able to move a little finger. I can clearly see his eyes move in the video. Could it be that Rom Houben recovered just minimally and that some want to take advantage of this? But why? And who are they? There is a mention, in the AP video, that Houben is considering writing a book. The mystery deepens...

So, as I said, you're basing your view only on news reports, not any first-hand knowledge of the case.

Science and medical reporting is extremely shoddy, so I would be very skeptical of drawing any conclusions based on claims you find there.

You say, "The fact that the patient can provide yes/no feedback with his foot..." But this is not a fact the way most people use the word; it is based on a single news report.

You say, "However, perhaps you are right and the method of communication that Laureys' team has developed is nothing more than FC." This is truly idiotic, Kirk. It is your invention entirely. I never said anything about Laureys using FC, and I have stated that quite clearly. Yet you continue to make this bogus claim. Do you have a reading comprehension problem?

You have provided no reason to believe that what we see in the video is not FC.

Well, Laureys' interests are certainly being served by the story. Laureys has apparently some unconventional ideas about comas, and he has been championing them. Whether Laureys uses FC himself, or whether he endorses its use by the person depicted in the video, is yet to be seen.

Jeffrey wrote, "So, as I said, you're basing your view only on news reports, not any first-hand knowledge of the case.

Science and medical reporting is extremely shoddy, so I would be very skeptical of drawing any conclusions based on claims you find there."

I can see two problems here. First, you have no first hand knowledge of the case either. Even worse, you made a public trashing of the method of communication that the patient is using, on the basis of a single video, whereas I took the time to view two different videos, read a news report that gave more details, look over the 2001 FC paper and read enough of it to see that if the patient can supply feedback, then it is not the sort of FC being discussed in that paper, download Laureys' paper and look at their methods, and email Laureys to inquire specifically of the news video regarding what sort of control the patient has over what is being typed if an assistant is holding or directing his hand. That is the sort of stuff you ought to have done before publicly stating that the communication technique you saw in a video is the bogus FC.

Second, you seem to want to distinguish the communication method seen in the video from the communication method developed by Laureys et al. If so, then you are making an assumption. My assumption is that we are seeing the method that Laureys et al have developed and it includes more than a quack using the man's finger to make up messages like you are assuming. Both of us are assuming something here, which is why I figured Laureys is the one to clear up the question.

As you say, science reporting can be shoddy sometimes but, if so, why are you publicly concluding that what we see is the bogus FC when all you have is 'shoddy' science reporting that contains only a few seconds of typing footage, you can't hear what the assistant is saying (probably not in English), and there is more info available that suggests that the patient is fully capable of feedback). If there is anything shoddy about the video, it is the lack of information, yet you drew a conclusion on the basis of a single video without doing any additional homework. Shoddy in, shoddy out.

I don't see anything getting resolved in this discussion unless Laureys enlightens us.

I see you are unable to admit you made up the claim that I said Laureys' team was using FC. So much for your honesty.

As for your "extensive" research - give me a break. You didn't even know anything about FC before I pointed it out. I have been studying the bogus claims of FC for years. I have seen it used in many different videos, and I can recognize it in the video used in this case. For one thing, the patient isn't looking at the keyboard. For another, the keystrokes come so rapidly they cannot possibly be the voluntary result of a patient who is exercising extremely weak control of his hand.

You have no idea how many videos I watched or how much research I did, so quit pretending that you did or that you did more than I.

And I sent e-mail to Laureys long before you did.

I have made no positive claims in this case, except that FC is being used in the video, which is obvious to anyone familiar with the technique - and you are not. Other than that, all I said was that I was skeptical.

You, on the other hand, repeatedly made positive claims about what you "know" to be true - despite the fact that you have no idea about the case except what is stated in news reports.

I received an email from Steven Laureys, the scientist who is associated in the media with the patient Rom Houben and the various news videos, one of which Jeffrey linked to in his introduction to this thread.

Here is my query in its entirety:

“This past week I observed a news video of patient Rom Houben. It appeared that the assistant was doing the typing for him. I am assuming that the communication method for Houben was developed by your research group. Can you tell me what sort of control Mr. Houben has over what is being typed? How did the assistant in the news video know that what is being typed is what Mr. Houbens wants to type?

Thank you for any clarification you can give me.”

Steven Laureys replied:

“hithis will be dealt with via the scientific pressthanks for your understandingsteven”

Not much info, but I note that he did not distance himself from the communication method seen in the news videos. We can infer from that, that what we are seeing in the video is a method that Laureys’ team has developed, or helped develop.

Now the question remains, is Laureys’ research group using FC or not? I notice that the video on the CBC news link I provided in my first post has been updated with one that contains significantly more information. It might be good to take a look at the new video, as it is a bit more informative that the last one.

Since Laureys was not forthcoming on what he intends to publish re. the method in the news video, I took a quick look at a list of recent papers that Laureys co-authored to see if there were any clues as to what sort of methods Laureys et al. are involved with. One method is described here. Looking over that abstract, it appears to me that Laureys et al. are involved in methods that are a good deal more sophisticated that simply hiring a quack to make up messages on a computer screen by using Houben’s finger as a pointer. Frankly, I am skeptical that the Coma Science Group at the University of Liege is so out of touch with modern neurological developments that they would be using a technique debunked back in 2001. Seeing a bit of what they are doing, I prefer to give the benefit of the doubt to Laureys’ group that Houben had full capability to provide feedback in whatever communication system they have developed.

Of course, I could be wrong, but I prefer not to draw a conclusion until I have sufficient information as to what is going on between Houben, the assistent, and that computer strapped to his chair. It is bad practice to leap to conclusions with insufficient evidence and I think that Randi, Caplan and Shallit have been a little too hasty on this one. A few seconds of video footage is pretty scanty data upon which to base a good conclusion.

You still refuse to admit you made up what I said about Laureys, I see. That's very sad. How can you live with this kind of dishonesty?

You draw an awful lot of conclusions from Laureys' refusal to answer your question. You say, "We can infer from that, that what we are seeing in the video is a method that Laureys’ team has developed, or helped develop", but I say you can't infer anything of the sort.

Again, if you look at the video you can clearly see FC is being used. The patient isn't even looking at the keyboard while the assistant moves his hand.

This article makes it completely clear that the bogus technique of facilitated communication is being used.

"The method involves taking Mr Houben by the elbow and the right hand while he is seated at a specially adapted computer and feeling for minute twitches in his forefinger as his hand is guided over the letters of the alphabet. Mrs Wouters said that she could feel him recoil slightly if the letter was wrong. After three years of practice the words now come tumbling out, she said."

Kirk can pretend all he wants that FC is not being used, but he's not fooling anyone.

Jeffrey, I don’t recall claiming that you ‘said’ that Laureys’ team was using FC. Are you trying to maintain the illusion that Laureys is not associated with the method being used in the news video? I think you have a pretty weak case if you are trying that move.

First, if you read my email question to him, I clearly state my assumption that ‘the communication method for Houben (‘observed in a news video’) was developed by your research group.’ Not only does Laureys not take the opportunity to correct my stated assumption, but he actually states that the method ‘will (future tense) be dealt with via the scientific press’. Pretty hard to question my inference on the basis of that, isn’t it?

Second, you neglected to mention Laureys’ endorsement of the method being used in the article you just cited above. Now, as we can all see in your posts, you’ve set the bar of civility and politeness pretty high, Jeffrey, with your example of respectful, collegial, and well thought-through conclusions and graciously worded responses, so I will avoid the temptation to accuse you of being dishonest for failing to mention some additional relevant information in the article you just linked to above. It was probably just an oversight, since you are such a busy man, but if I can direct the audience’s attention to just a bit further down in the article, it states, ‘The spectacle is so incredible that even Steven Laureys, the neurologist who discovered Mr Houben’s potential, had doubts about its authenticity. He decided to put it to the test.“I showed him objects when I was alone with him in the room and then, later, with his aide, he was able to give the right answers,” Professor Laureys said. “It is true.” ’”So given this statement by Laureys, I cannot understand why you would still want to live in denial that Laureys’ team is not endorsing what we see in the video.

Caplan made his hasty statement after watching a video, the article states, and then went on to say that such mode of communication has been ‘descredited time and again when people look at it.’ The trouble is, what is going on in the video was tested and it was not falsified. Caplan made this statement on the basis of a few seconds of video footage while failing to do his homework on Laureys and Houben. Thus Caplan, professor of bioethics, has done something that is unethical. If one is going to publicly mock another person, accusing them of ‘ouija board stuff’, then ethics demands that such a person do some very careful research on the case before lumping it in with quackery. In Houben’s case, Laureys did test the method which is based upon small muscle movements. That is what science does. Wouters’ claim (that Houben’s small muscle movements in his finger, and his ability to pull back when a mistake was made, enabled her to accurately translate those muscle movements into keystrokes) was set up for possible falsification by Laureys’ test. Whole prosthetics are designed to work on the basis of small muscle movements. If you will take the time to look at the FC article you linked to, you will see that this does not fall into the category of examples that fail when tested. This was verified when tested. In science, you can test claims and that was done by Laureys in this case. I would imagine that the next step for Houben is to have a prosthetic device built that can translate Houben’s small muscle movements into larger, more controled movements that can include, among other things, at least self-directed, one-finger typing without any human assistance at all. I also fully expect that there will be a paper forthcoming on this method, on the basis of Laureys’ email to me.

So it seems to me, Jeffrey, that you have to concede:

a) that Laureys tested the method by setting it up for possible falsification (described in the most recent article you linked to above), and the method was verified and,b) as a result, Laureys publicly endorses the method, as mentioned in the same article.

The only thing I have to concede, Kirk, is that you are even more arrogant and moronic than I thought possible.

I will repeat it again for the third time - maybe you will listen this time. I am not claiming that Laureys' team uses FC. Your comment implying that I did so is there in plain sight - how about reading it? Evading won't cut it.

What is more and more apparent is that Laureys has been taken in by the phony technique of FC.

You say, "Pretty hard to question my inference on the basis of that, isn’t it?" Hardly - it is completely consistent with the idea of an honest scientist being taken in by a fraudulent technique.

You claim, "This was verified when tested." No, it wasn't. The fact that you think it was "tested" by Laureys' simple-minded check shows (a) you know absolutely nothing about the fraudulent history of FC and (b) you know nothing about how to construct an experiment that is cheat-proof. Good but naive scientists have a long history of being taken in by charlatans - read, for example, about Uri Geller's spoonbending antics.

Can you think of any way that Laureys' simple-minded check, as described in the article, could have been rigged by someone with a vested interest in maintaining the deception? Off-hand, I can think of three.

And your libelous comment about Caplan is truly despicable.

But, by all means, continue your charade of believing that FC was not being used. I notice you are unable to explain the patient's magical ability of typing without looking at the keyboard!

What I find disgusting in this case is that some people take advantage of other people's feelings. It is so easy (and cheap) to give hope when you know there is none and when you know that people live on it and some are prepared to believe anything in exchange of a little hope. I, too, before reading this post, had no clue of FC. But now, having looked around, I have concluded it's entirely bogus.

Taking advantage of people's feelings and hopes is hideous. This is exactly what religion does.

Well, Jeffrey, it's been a pleasant exchange, but the weekend is here and as much as I enjoy your usual jovial company and well thought-through compliments, it's time to party. Happy American Thanksgiving to one and all.

establishes without a doubt that my interpretation, and not Kirk's, is correct.

Laureys says, "But I am not the one who made him communicate with the touch screen, I was just there to help him get rid of the diagnosis of vegetative state."

So, as I surmised, Laureys did not have anything to do with "sponsoring" the facilitated communication nonsense - contrary to what Kirk claimed was obvious. And Laureys is also clearly a naive victim of FC nonsense, since he seems to believe that the patient is actually communicating via this technique.

Will I get an apology from Kirk for his wild deductions? Not bloodly likely.